NEW YORK (Reuters Health) – In a large study of high-risk hypertensive patients, treatment with the angiotensin-converting-enzyme (ACE) inhibitor benazepril plus the calcium-channel blocker amlodipine proved more effective than treatment with benazepril plus the diuretic hydrochlorothiazide in reducing the risk of cardiovascular events and of death.

The findings, from the ACCOMPLISH (Avoiding Cardiovascular Events through Combination Therapy in Patients Living with Systolic Hypertension) trial, appear in the December 4 issue of The New England Journal of Medicine.

In this randomized, double-blind study, 11,506 hypertensive adults at high risk for cardiovascular events were randomly assigned to the benazepril-amlodipine combination (n = 5744) or the benazepril-hydrochlorothiazide combination (n = 5762).

Both drug regimens produced a high rate of blood pressure control, the investigators note. Mean blood pressures after dose adjustment were 131.6 over 73.3 mm Hg in the benazepril-amlodipine arm and 132.5 over 74.4 mm Hg in the benazepril-hydrochlorothiazide arm.

However, marked between-group differences in the primary outcome — a composite of illness and death from cardiovascular causes — led to early termination of the trial after a mean of 36 months.

There were 552 primary-outcome events in the benazepril-amlodipine group (9.6%) and 679 in the benazepril-hydrochlorothiazide group (11.8%), representing a relative risk reduction of approximately 20% (p < 0.001) with the benazepril-amlodipine combination.